The real story of psychiatry
Background and beginning of psychiatry
While there were dozens of personalities, hundreds of thousands of words written, and often pretentious complexities on the subject of psychiatry in the 19th and 20th centuries, we are going to concentrate on just a few that are particularly relevant to the state of psychiatry today.
Segregation in asylums
For more than 1,000 years the primary solution for the mentally ill, when not cared for within the family, was to segregate them from the rest of the population into lunatic asylums. These asylums were often attached to hospitals or churches.
In the 18th century, privately run asylums began to appear as commercially run facilities – or what was called ‘the trade in lunacy.’ By the end of the 19th century, large state-run asylums were being built to house increasing numbers of mentally ill.
At times appalling treatments and conditions in asylums were improved however any such improvements were never matched by a science of mental health that would provide cures.
A lost renaissance for mental health
…this period, paralleled by scientific advances, should have resulted in a true renaissance in the treatment of those deemed to be mentally ill. Yet, it resoundingly did not.
Following a scientific revolution of the 16th and 17th centuries, the West’s Enlightenment or The Age of Reason of the 17th and 18th centuries brought about a search for new ideas in many areas including philosophy, science, medicine, politics, government, and new freedoms in the relationship between individual men and their societies.
It is from this background that interest grew in two areas: What we now know as psychology which includes in addition to clinical applications, philosophical consideration and speculation on exactly what was man, and second what we know as psychiatry, attempts at practical solutions to the problem of increasing deterioration of mental health among populations and equally speculative theories as to the cause.
In a practical sense, a few schools of thought of what was to become psychiatry were emerging at the end of the 19th century. For example, one of these was psychoanalysis originating with Sigmund Freud, Josef Breuer, and others which involved addressing the mind and dealing with the various thought behaviors, and personality forces that meld into a person. Another was ‘biological psychiatry’ which involved the idea of all psychiatric conditions being due to entirely biological ‘illnesses’, which originated primarily with Emil Kraepelin, influenced by Wilhelm Wundt.
Without further consideration of the validity of this or that school of thought, this period paralleled by scientific and philosophical advances, should have resulted in a true renaissance in the treatment of those deemed to be mentally ill. Yet, it resoundingly did not.
Neither psychoanalysis nor biological psychiatry has ever found the cause of what is called mental illness nor cured anyone.
While psychoanalysis gained popularity after World War II, particularly in the United States, the ‘biological psychiatry’ of Kraepelin has, for the most part, dominated the subject and currently does. The search for the reason behind our lost renaissance should start there.
Wilhelm Wundt and ‘physiological psychology’
Originally trained in physiology, Wundt is considered to be the “father of experimental psychology” and established the world’s first Laboratory of Experimental Psychology in 1879, at the University of Leipzig. Apart from his laboratory, Wundt laid claim to being a philosopher. Up until this time, psychology was seen to be part of the broader subject of philosophy. Wundt was intent on separating his opinions on mankind from the existing subjects and traditions of both philosophy and psychology and undoubtedly basing it on his earlier training in physiology, created a subject called ‘physiological psychology’.
Having no evidence other than his opinions, Wundt speculated man to merely be a body with a brain and nervous system, indeed in direct opposition to many of the tenets of philosophy and further, denying cultural understanding and knowledge going back millennia.
For Wundt, anything such as the mind, consciousness, will, ethics, creativity, and indeed mankind’s spirituality simply didn’t exist beyond the brain and nervous responses. Following on from his debasement of the higher faculties and aspirations of mankind, in Wundt’s view any deterioration of mental health could only be due to biological factors and these are only found in the brain and nervous system. 1 2 3
“The Cartesian soul can no longer exist in face of our present-day physiological knowledge of the physical substratum of our mental life.”
Wilhelm Wundt. An Introduction to Psychology. 1911. 4
(‘Cartesian soul’ in this use by Wundt is in reference to the concept of dualism i.e. that human beings consist of separate parts; the immaterial mind or soul defined as thinking, and the material body defined as matter and unthinking. This concept was put forward by the French philosopher, scientist, and mathematician René Descartes (1598 – 1650), who is recognized as an important figure in the development of modern philosophy and science. However, similar concepts have existed in philosophy and religion in man’s cultures for as long as available history.)
“General psychical disturbances are always symptoms of diseases of the brain, so that these abnormities in affective and volitional processes are doubtless accompanied, like those of the sensations and ideas, by physiological changes.”
Wilhelm Wundt. Outlines of Psychology. 1897. 5
Following on from his debasement of the higher faculties and aspirations of mankind, in Wundt’s view any deterioration of mental health could only be due to biological factors and these are only found in the brain and nervous system.
Presenting his ‘physiological psychology’ as a science, many persons from Europe and the United States with an interest in related fields traveled to Leipzig to study under Wundt. While some remained unconvinced, it should not be underestimated the wide and negative influence of Wundt’s ideas on the Humanities including Education, and particularly Psychology, and Psychiatry.
It should be stressed that no evidence for Wundt’s assumptions has ever been found – in his own day or since even when using the most sophisticated equipment modern science has to offer. And yet, you will find these ideas masquerading as ‘science,’ even being taught in schools.
While Wundt’s influence spread across the world, it was Germany where the full extent of this influence was felt. One only has to look 10 years after his death for the catastrophic consequences of these ideas to manifest in German psychiatry through his student Emil Kraepelin.
Emil Kraepelin and the beginning of biological psychiatry
Of those who came to Leipzig to study under Wundt, probably the most influential was Emil Kraepelin. Kraepelin spent 1877 as a medical student studying under Wundt. He was so enamored by Wundt’s opinions that he spent 1882 and 1883 in post-doctorate studies at Wundt’s Laboratory of Experimental Psychology. 5
For context, neither Wundt nor Kraepelin presented any great scientific advances in physiology, psychology or psychiatry. Kraepelin, under Wundt’s supervision, primarily involved in doing drug research consisting of testing the effect of various drugs (including coffee, tea, strychnine, and hashish) on human reaction times, while studying Wundt’s book ‘Principles of Physiological Psychology’.
Due to his emphasis on drug experimentation, some would consider Kraepelin to be the ‘father of psychopharmacology ‘ however, neither he nor others of his time had any idea of what actually caused what they were describing as mental illnesses and his random drug experiments were more based on searching for serendipity, addressing symptoms, than an expression of any scientific theory. 6
Kraepelin would never find any validation of his theory in his lifetime, i.e. he never found any piece of evidence of any biological cause of mental illness and there are suggestions he gave up looking.
Kraepelin extended Wundt’s speculation on the cause of mental illness and formulated the basis of ‘biological psychiatry’; that all mental illness is due to entirely physical, biological causes and involves diagnosing and treating symptoms of biological diseases in the brain (with anything else being irrelevant including the mind, if it existed at all). This theory has for the most part, dominated psychiatry for more than 100 years and yet Kraepelin would never find any validation of his theory (or indeed Wundt’s speculations) in his lifetime, i.e. he never found any piece of evidence of any biological cause of mental illness in the brain or otherwise and there are suggestions he gave up looking. 7 8
“The magnitude of the efforts to be expended on our task, the impenetrable darkness that hides the innermost workings of the brain and their relation to psychic manifestations, and finally the inadequacy of our instruments for dealing with extremely complicated issues, must cause even the most confident investigator to doubt whether it is possible to make any appreciable progress toward psychiatric knowledge and understanding; indeed, it has not been very long since some of our best researchers turned to related disciplines in search of rewards not afforded by psychotherapy.”
Emil Kraepelin. 1917. One Hundred Years Of Psychiatry. 9
By 1903, Kraepelin moved to Munich to take up a professorial position there. As some indication of the popularity of his theories in psychiatric circles, he was elected the head of the German Association for Psychiatry, a position he held from 1906 to 1920.
Indeed a chief rival of his, Sigmund Freud would go on to call Kraepelin a ‘super Pope’ of psychiatry and:
“a true psychiatrist mustn’t see anything that is not in Kraepelin”
Sigmund Freud 10
A chance meeting with the wealthy American banker James Leob (son of Simon Loeb of Kuhn, Loeb & Co., the Rockefeller Foundation’s investment bank) resulted in Leob becoming Kraepelin’s patient. What followed was the funding and establishment of Kraepelin’s German Institute for Psychiatric Research in 1917. This was soon incorporated into the Kaiser Wilhelm Society for the Advancement of Science and with further funding from the Rockefeller Foundation from 1926 on, resulting in the institute apparently becoming the leading international research and education facility for psychiatry in what was otherwise a rather bleak and dispersed subject of conflicting theories and ideas.
Being in alignment with his ideas concerning ‘biological psychiatry’, Kraepelin also ardently embraced the late 19th and early 20th-century eugenics movement that had found favor with some of the intelligentsia throughout Western countries and from his position, became a leading advocate of it.
“For example, many psychiatrists from abroad were fellows at the newly founded German Kaiser Wilhelm Institute for Psychiatry headed by Emil Kraepelin. Kraepelin and his pupil and successor Ernst Rüdin, who first headed the Genealogical Department of the Research Institute under Kraepelin’s directorship, were two prominent figures who were ardent advocates of the degeneration and domestication hypotheses, and both did not make a secret of their views that domestication was the main causal factor for the alleged increasing prevalence rates of mental disorders and deterioration of the genepool. In his article Zur Entartungsfrage (“On the question of degeneration”, 1908) Kraepelin complained about a steady increase in psychiatric disorders in civilised people, while mental disorders remained comparably rare in “primitive” races.”
Brüne M. On human self-domestication, psychiatry, and eugenics. 11
This ‘causal factor’ of degeneration and domestication was not a clinical tool. Just as with ‘biological psychiatry’ and its emphasis on the brain, eugenics offered no possible cures for the individual afflicted.
Yet, within a few years, not only was the lack of scientific credibility of psychiatry confirmed but the world was left reeling from the monstrous legacy of Wundt and Kraepelin – German psychiatry – when the truth was finally known.
Speculative thought leads to nothing
By the 1930s psychiatry had drawn the attention of the Rockefeller Foundation and a committee was formed under David L. Edsall, Dean of Harvard Medical School and Rockefeller Foundation trustee to determine the state of the subject. Edsall and the committee’s report to the Rockefeller Foundation described a subject based merely on speculation without any advances in real knowledge and unlikely to provide any.
“In most places psychiatry now is dominated by elusive and inexact methods of study and by speculative thought. Any efforts to employ the more precise methods that are available have been slight and sporadic. Often they have not been used at all. It is, of course, more difficult to use them in psychiatry than in the more definitely physical aspects of medicine, but there has been little employment of the methods that are open to use, in psychiatry itself, and there has been little change in real knowledge. Such alterations in thought as have occurred have been largely due to the work done by the physiologists, particularly Pavlov, Cannon and Sherrington...
“Furthermore, so wide a field is involved, and such numerous and diverse factors are considered in the common conception of psychiatric investigation, that it is difficult to conceive of any great success coming from such a line of attack. Medicine worked through its most hazy and uninformed stage, as most other scientific lines of work have done, by adding bit by bit fragments of knowledge which ultimately could be put together to make an important whole, in one case after another.
“Only rarely was a problem solved as a whole and at one time and then always when before that a background of exact knowledge applicable to the problem had been accumulated in disconnected fragments. The tendency still, with a large proportion of workers, in psychiatry is to attack the whole in all its bearings and to try to work in that way towards precise knowledge. The same criticism is applicable at present that Charcot made a half-century ago, namely, that the medical man was contented with finding small fragments of knowledge, but the psychiatrist insisted upon making such a comprehensive attack that he accomplished nothing.”
David L. Edsall. Dean of Harvard Medical School. 1930. 12
“…the medical man was contented with finding small fragments of knowledge, but the psychiatrist insisted upon making such a comprehensive attack that he accomplished nothing.”
David L. Edsall. Oct 3, 1930
Aktion T4 – German psychiatry’s descent into hell
Going beyond the words of David Edsall, what were the consequences of the Wundt/Kraepelin theory on mental health in the country most affected? Did this theory that all mental illnesses are entirely diseases of the brain improve the treatment of the mentally ill in Germany? Were people being cured?
Kraepelin’s ‘schizophrenia’ and overcrowded asylums
In 1893 Emil Kraepelin put forth his definition for ‘dementia praecox’ or what became known as schizophrenia. Including the influence of wars and other social factors, Kraepelin’s new ‘disease’ also resulted in large increases in people being sent to asylums ( in many other countries as well as Germany). While defined, Kraepelin offered no cause nor cure for the condition (or any other ‘mental illness’) and German asylums were soon seriously overcrowded – the number of patients in asylums was estimated to be some 300,000 by 1929. 13 14
Psychiatry’s solution: sterilization or murder
Having no idea of the actual cause or cure of what they were calling mental illness, German psychiatry’s only solutions were firstly to sterilize the mentally ill and disabled and secondly, to simply murder them.
“Genetic psychiatry’ and sterilization of the mentally ill
On July 14, 1933. The German Reich (Nazi) government passes the Law for the Prevention of Offspring with Hereditary Diseases.
As a result, it is estimated that 400,000 persons were sterilized between 1934 and 1945:
“A diagnostic breakdown of sterilizations for 1934, the only year for which such figures are available, indicates that 49% of the sterilized individuals had “congenital feeblemindedness,” 26% schizophrenia, 16% congenital epilepsy, and the remainder other diagnoses”
E.Torrey and R H.Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. 15
In this perverse extension of ‘biological psychiatry’ into eugenics, we see the hand and direct influence on Emil Kraepelin through his former students and proteges.
“Kraepelin’s pupil and successor as head of the Kaiser Wilhelm Institute for Psychiatric Research, Ernst Rüdin, who later was involved, together with Fischer, Baur, Lenz, and others, in the introduction of the “law of prevention of hereditary diseased offspring” (“Gesetz zur Verhinderung erbkranken Nachwuchses”) greatly acknowledged Kraepelin’s attitude. In a paper published in 1910 in the Archiv für Rassen – und Gesellschaftsbiologie (Archives of Racial and Societal Biology), which was one of the leading journals in the field of genetics and eugenics, and of which Rüdin was co-editor-in-chief, he reasoned that the medical care for the insane was a distortion of the natural laws of the survival of the fittest and that medicine would be obliged to clean the genetic pool of the Volk in order to prevent ongoing degeneration.”
Martin Brune. On human self-domestication, psychiatry, and eugenics.16
In addition to his direct contributions to the writing of the ‘Law of prevention of hereditary diseased offspring’, Ernst Rudin, was also President of the Society of German Neurologists and Psychiatrists (GDNP), later renamed the German Association for Psychiatry, Psychotherapy and Neurology (DGPPN) from 1935 to 1945. He had considerable influence in propagating his and the ideas of his mentor Kraepelin, throughout the psychiatric and German culture.
So influential was Rudin in doing so that he was nicknamed the “Reichsfuhrer for Sterilization” by his NAZI cronies. 17
Another of Kraepelin’s former students and proteges was Robert Gaupp who studied under Kraepelin in 1901 and worked with him at the Universities of Munich and Heidelberg.
“Gaupp’s school gave rise to constitutional research and clinical psychotherapy. In particular, his advocacy of “racial hygiene” forced sterilization, which he advocated in lectures and contributions such as “The Sterilization of the Mentally and Morally Ill and Inferior” (1925) and “The Sources of the Degeneration of Man and people and the Ways of Repentance” (1934), prepared the ground for National Socialist eugenics.”
“Nachlass Professor Dr. Robert Gaupp” Landesarchiv Baden-Württemberg.18
Aktion T4: murder of the mentally ill and disabled.
Not satisfied with their sterilization programs, German psychiatrists under the direction of Kraepelin proteges and in collusion with the now NAZI German government under Adolph Hitler, pushed to implement their existing plans to exterminate the occupants of asylums and others designated as mentally disabled – Aktion T4.
In 1939 a draft law, a memorandum on “the destruction of life unworthy of life” included the following provision:
“The life of a person, who because of incurable mental illness requires permanent institutionalization and is not able to sustain an independent existence, may be prematurely terminated by medical measures in a painless and covert manner.”
E.Torrey and R H.Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. 19
While this law was never published, Hitler put Aktion T4 into effect by direct order and promised immunity for those involved. The order was actually signed in October but backdated to 1 Sept 1939.
The order reads:
“Reich Leader Bouhler and Dr. Brandt are entrusted with the responsibility of extending the authority of physicians, to be designated by name, so that patients who, after a most critical diagnosis, on the basis of human judgment [menschlichem Ermessen], are considered incurable, can be granted mercy death [Gnadentod].”
A Hitler.
“The asylums competed with each other and celebrated achieving targets. For example, the Hadamar asylum… “celebrated the cremation of its ten-thousandth patient in a special ceremony, where everyone in attendance—secretaries, nurses and psychiatrists—received a bottle of beer for the occasion.”
E. Fuller Torrey and Robert H. Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia
“In October 1939, the directors of all German psychiatric hospitals were asked to fill out forms indicating the diagnosis and capacity for useful work of each patient, although they were not told what the forms were for. These forms were then assessed by a committee of selected psychiatrists who targeted approximately 70,000 patients for death, 1 for every 1000 people in Germany, which was the initial goal of the program.”
E.Torrey and R H.Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. 20 21
Six ‘killing centers’ were established and the patients about to die were bused to their doom.
“In January 1940 the first 20 patients were led into the ‘shower rooms’ at the Brandenburg Asylum and killed. The asylums competed with each other and celebrated achieving targets. For example, the Hadamar asylum… “celebrated the cremation of its ten-thousandth patient in a special ceremony, where everyone in attendance—secretaries, nurses and psychiatrists—received a bottle of beer for the occasion.”
E.Torrey and R H.Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. 22
The Aktion T4 program was ‘officially’ ended after the first 70,000 deaths however in practice was extended throughout areas of NAZI Germany’s control to the end of World War II. Originally only involving asylum patients killed through the use of carbon monoxide gas, the program was extended into Germany and occupied territories where patients were also killed in their asylums by lethal injections, being shot or an estimated 100,000 simply left to starve. 23
Between 1940 and 1945 it is estimated that more than 270,000 disabled and asylum patients – men, women, and children – were murdered in Germany, Austria, Poland, and parts of what is now the Czech Republic.
While under the control of the NAZI SS, the medical director of Aktion T4 was psychiatrist Paul Nitsche, who was a protege of Kraepelin and had worked directly under his supervision at Munich University.
Nitsche was the director of the Sonnenstein Hospital from 1928 to 1939 which became one of the Aktion T4 killing centers. 24
In 1940 Nitsche became the Deputy Director of Aktion T4 and by 1941 the program’s chief medical officer and psychiatrist who had the duty of selecting people who would be labeled “unworthy of life” – those who were to die. He sent thousands to their deaths – including at least 60 he personally killed through human experimentation. 25
After World War II, Nitsche was tried for his crimes against humanity and executed by guillotine in March 1948.
“They acted on their own”
Through all of the excesses of Aktion T4 it should never be assumed that German psychiatrists were ever under threat or duress regarding their crimes:
“The tragedy is that the psychiatrists did not have to have an order. They acted on their own. They were not carrying out a death sentence pronounced by someone else. They were the legislators who laid down the rules for deciding who was to die; they were the administrators who worked out the procedures, provided the patients and places, and decided the methods of killing; they pronounced a sentence of life or death in every individual case; they were the executioners who carried out or – without being coerced to do so – surrendered their patients to be killed in other institutions; they supervised and often watched the slow deaths.”
F Wertham. A sign for Cain: An exploration of human violence. 1966. 26
This display is on the wall of what was the Sonnenstein killing center.
The display shows the layout of the killing center with a waiting room, gas chamber, morgue, crematorium, and chimney room.
“Employees drove the patients and residents from mental hospitals and homes to the killing centre by buses. Physicians [psychiatrists] working for Organization T4, had classified them in terms of the Nazi ideology, as ‘unworthy of living’. Nurses guided them to the commission supervised by doctors on the ground floor of the building. The doctors verified the victims’ identity and assigned them a fraudulent cause of death.”
Sonnenstein killing center display
The Recording Room of the Hartheim Killing Center.
During the first use of the killing centers under Aktion T4, patients’ details would be recorded, and then they were taken down the corridor on the left to the gas chamber.
The lists on the walls are the names of persons who were executed in the gas chamber.
As just one of the seven killing centers, during the official Aktion T4 executions, 18,269 patients were murdered over a period of 6 months from 1940 to 1941. The gas chamber continued to be used right up to 1945 where it is estimated an additional 12,000 patients and concentration camp inmates were also executed.
Archeological digs beside the Hartheim Castle have found remnants of the Aktion T4 killings.
After death, the bodies were incinerated and bones ground to dust. What remained of both bodies and belongings the patients had brought with them were thrown into the Danube or buried in the Hartheim grounds.
Source of the NAZI racial hygiene policy
To assign the horrors of Aktion T4 and the NAZI racial hygiene policies solely to Adolph Hitler and his cronies is nonsense. It is more a case of the NAZI party and German psychiatry using each other to forward their own ends. As Kraepelin’s successor, Ernst Rüdin said:
“The significance of Rassenhygiene [racial hygiene] did not become evident to all aware Germans until the political activity of Adolf Hitler and only through his work has our 30-year-long dream of translating Rassenhygiene into action finally become a reality.”
Ernst Rüdin. 27
Rudin was well known to Adolph Hitler and there would have been no possible misconception of Kreapelin’s hand in all of this as well.
“In 1939 Rudin was presented a Gothe Medal by Hitler himself as the ‘meritorious pioneer of the racial-hygienic measures of the Third Reich’.” 28
In 1944, Rudin received a bronze medal bearing the Nazi eagle from Adolf Hitler, who lauded him as the ‘pathfinder in the field of hereditary hygiene’. 29
“…dreamers, poets, swindlers and Jews” possess ‘distinctly hysterical traits’ and fall outside the bounds of normality, adding that Jews exhibit “frequent psychopathic disposition.” These tendencies, he noted, are most importantly accompanied by “their harping criticism, their rhetorical and theatrical abilities, and their doggedness and determination”
Emil Kraepelin. 1919. 30
And another Kraepelin protege Robert Krupp went even further, describing the work of Kraepelin as the foundation of the NAZI racial hygiene laws which Krupp was implementing:
“A decade later in 1938, Robert Gaupp believed that his [Kraepelin] work was ‘indestructible’ and that it comprised nothing less than the ‘precondition of all research’ in psychiatry and the foundation of Nazi racial hygiene laws.”
Eric J. Engstrom, Matthias M. Weber. Making Kraepelin history: a great instauration? 31
And of Emil Kraepelin himself? Kraepelin had an entirely perverse view of his fellow men and while dying in 1926, undoubtedly would have rejoiced at the actions of NAZI German exterminators.
Blueprint for The Holocaust
While Aktion T4 was appalling enough, it should be known that the collusion between the NAZIs and German psychiatry aimed at a far greater evil.
The planning and operation of the Aktion T4 killing centers became the blueprint for The Holocaust, right down to such details as the gas chambers being built to appear like shower rooms. Many of the personnel from Aktion T4 simply transferred to the concentration camp extermination programs.
“According to the records, 275,000 people were put to death in these killing centers. Ghastly as this seems, it should be realized that this program was merely the entering wedge for exterminations of far greater scope in the political program for genocide of conquered nations and the racially unwanted. The methods used and personnel trained in the killing centers for the chronically sick became the nucleus of the much larger centers in the East, where the plan was to kill all Jews and Poles and to cut down the Russian population by 30,000,000.”
Doctor Leo Alexander. Medical advisor during the Allied trials of crimes against humanity by NAZI doctors and a contributor to the ‘Nuremberg Code’ that covered human experimentation which was written after the trials. From ‘Medical Science Under Dictatorship’ July 1949. 32 33
Had the NAZIs succeeded and been victorious in World War Two, one is left with the possibility of a horror future where NAZI conquests would be followed by psychiatric killing programs of the mentally ill and disabled and other unwanted populations. It is indeed the fantastical stuff of nightmares and yet it has already occurred in Aktion T4 and The Holocaust.
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- E. Fuller Torrey and Robert H. Yolken. Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. Schizophr Bull. 2010 Jan; 36(1): 26–32.
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